Surgeon develops cataract specialty

Issue: October 2007

Abhay R. Vasavada

When cataract surgery was considered only part of general ophthalmic practice rather than an important specialty, one determined surgeon focused his energies on its advancement as a specialty in order to address some of the more pressing issues facing Indian cataract surgeons.

“My senior colleagues in India were telling me this is a mistake because cataract can never be a specialty. [They said,] ‘You better take retina or some other thing. Everybody does cataract, so there is no point in doing cataract as a specialty,’ but I was convinced,” Abhay R. Vasavada, MD, FRCS, founder and director of Iladevi Cataract and IOL Research Center in Ahmedabad, told Ocular Surgery News in a telephone interview.

From working to improve the quality of training to studying the epidemiology of congenital cataract, Dr. Vasavada has committed himself to establishing cataract surgery as a specialty in India.

Desire to improve training

Dr. Vasavada studied medicine and ophthalmology at Baroda Medical College, where he earned a master of surgery in ophthalmology in 1975. But gaps in his education in India led him to go to the United Kingdom in 1976 for further study and work experience.

“In Baroda, I really didn’t have much teaching myself. There wasn’t any organized teaching, so I went to England with the hope that I would get good teaching,” he said.

Dr. Vasavada spent more than 6 years in England, where he worked for 2 years as a senior registrar at Moorfields Eye Hospital and became a fellow of the Royal College of Surgeons.

Although he was eligible to become an ophthalmic consultant in England, it was his desire to improve cataract training in India that compelled him to return with new insights into education.

“I thought, ‘I want to do a teaching to the doctors in India where I didn’t have it done. I hope I can teach them.’ One of the driving desires was to teach on my return,” he said. “In general, the evolution [of cataract surgery] was slow, and I wanted to make it rapid and pass it on to many other people.”

Dr. Vasavada started his career in India by becoming a lecturer at NHL Medical College and teaching residents. By the late 1980s, he had decided to dedicate his career entirely to teaching and researching cataract surgery and was the first Indian ophthalmologist to declare himself solely a cataract specialist.

“I thought the quality of the surgery at that time, the management, wasn’t good, so I thought if I could improve on the cataract surgery outcomes that would be nice. So that really drew me to take up cataract as a major focus area,” he said.

Opening a research center

Dr. Vasavada opened his self-financed research center not only with the intention of training residents in cataract surgery techniques but also with specific research topics that he felt required more focused attention.

“I started it in the early ’90s with a view to research why the cataracts occur in young individuals in India. We get patients who are in their 30s who were apparently healthy and still have cataract, and I never had that many patients when I was in training [in England],” he said.

Working with this patient group has allowed Dr. Vasavada to conduct clinical studies such as one recently published study in which he evaluated phacoemulsification in adults younger than 50 years and discovered challenges in creating a capsulorrhexis as well as a high incidence of posterior capsular opacification.

With the center, he also aimed to answer questions about congenital cataract and currently employs three researchers.

“It’s a small set-up, but we are doing decent work related to cataract in children and in young adults. That’s what my primary focus has come to be,” he said.

Students conducting research at Iladevi Cataract & IOL Research Center. Projects include genetic mapping of cataract types.

Images: Vasavada AR

Congenital cataract research

India is home to a particularly high number of congenital cataract patients compared with the rest of the world, according to Dr. Vasavada. Statistics show that cataract is responsible for 10% of the blindness found in young children.

Many of these patients are sent to Dr. Vasavada’s center, where he often treats them for free.

He has also been collecting clinical data at the center to produce epidemiological studies and analyses of surgical outcomes and optimal techniques.

“I am collecting a lot of experience and results, and I am trying to produce those evaluation studies on that,” he said.

A study he published in 2004 showed congenital rubella syndrome and parentage to be causes of congenital cataract cases. However, Dr. Vasavada told OSN that further experience has shown prematurity and low birth rate to be more likely reasons.

“Any of these or both of them is the leading cause for cataract,” he said. “That is the reality in India compared to other societies in the world.”

Breaking new ground

One current project at the center is a collaboration with the Centre for Cellular and Molecular Biology in Hyderabad that will map the genetic profiles of different kinds of cataract.

“I want to establish a genetic chart, which gives the profile of the cataracts – at least in western India from where I get more patients – so that if a child comes with a cataract, we have at least a tentative short listing of the genetic defects or genes that can lead to this in our population,” Dr. Vasavada said.

He also began a randomized, prospective study evaluating the efficacy and safety of IOLs in congenital cataract patients to learn whether they are the best option.

“There is no evidence at the moment that IOLs are safe and effective in infants and also in children of 2 years, so I have taken on this ambitious project for the last year and a half,” he said.

In addition to his work with children, Dr. Vasavada is working to prove the superiority of phacoemulsification over techniques such as small-incision cataract surgery.

“I have been involved in projects and studies where we wish to prove and create evidence that phaco gives a better visual outcome and a rapid rehab. It will work out economically in terms of man hours, lost time,” he said. “We are planning a multicenter study with some centers in India to do that.”

He is also working on establishing phaco at a rural clinic he runs in the town of Dholaka, where he and colleagues provide phaco procedures.

“My whole staff runs that show, and we do it totally free. So phaco is possible even at a community level; that’s what I want to prove to the world,” he said.

According to Dr. Vasavada, he would not have been able to work on such unique projects had he chosen to remain in England.

“I opted [to return] here, and I wasn’t sure it was the right thing. I am so happy that I made that decision, more so for cataract specialists because the opportunities I get here I would not have gotten anywhere else,” he said.

For more information:

Abhay R. Vasavada, MD, FRCS, can be reached at Iladevi Cataract & IOL Research Center, Raghudeep Eye Clinic, Gurukul Road, Memnagar, Ahmedabad – 380 052, India; +91-79-27492303; fax: +91-79-27411200; e-mail: icirc@abhayvasavada.com.

References:

Johar SR, Savalia NK, Vasavada AR, Gupta PD. Epidemiology based etiological study of pediatric cataract in western India. Indian J Med Sci. 2004;58:115-121.

Dholakia SA, Vasavada AR, Singh R. Prospective evaluation of phacoemulsification in adults younger than 50 years. J Cataract Refract Surg. 2005;31:1327-1333.